MEDICARE: LEROY CHARLES MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	ME83408	FL

General Provider Information

NPI Number	:	1134596646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEROY CHARLES MD PA

Provider Business Mailing Address
First Line	:	4849 LAKE WORTH RD
Second Line	:	SUITE 201
City	:	GREENACRES
State	:	FL
Zip	:	33463-3461
Country	:	US
Telephone Number	:	561-784-7014
Fax Number	:

Provider Business Practice Location Address
First Line	:	4849 LAKE WORTH RD
Second Line	:	SUITE 201
City	:	GREENACRES
State	:	FL
Zip	:	33463-3461
Country	:	US
Telephone Number	:	561-784-7014
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEROY CHARLES
Credential	:	MD
Telephone Number	:	561-784-7014

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	09/01/2015

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